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With all of Medicare‘s different rules for enrolling, it’s not unheard of to miss your signup deadline.
Now is the time to remedy that.
During a general enrollment period that opened Jan. 1 and closes March 31, anyone who did not enroll when they should have (as defined by the government) can do so. The downside is that coverage won’t start until July. And, you may face a late-enrollment penalty.
This opportunity for late enrollment is separate from a concurrent three-month window for beneficiaries who want to drop their Medicare Advantage Plan or switch to another.
Here’s what to know if you’re signing up late.
Generally speaking, you are supposed to sign up for Medicare during a seven-month window that starts three months before your 65th birthday month and ends three months after it. However, if you meet an exception — i.e., you or your spouse have qualifying group insurance at a company with 20 or more employees — you can put off enrolling.
Workers at those larger employers often sign up for Part A (hospital coverage) — because it is premium-free for most beneficiaries — and delay Part B (outpatient care) until they lose their other coverage. Then, they generally get eight months to enroll. If that special window is missed, they would generally have to wait until this annual general enrollment period to sign up.
The rules are different, though, for companies with fewer than 20 employees: Those workers are supposed to enroll when first eligible.
“We see people run into this when they work for small employers; they should have signed up at age 65 but they didn’t,” said Danielle Roberts, co-founder of insurance firm Boomer Benefits. “Later, when they figure that out, they are often already past their [initial enrollment period] and have to wait.”
And while you shouldn’t wait until the last minute to enroll during this current three-month period, the Social Security Administration will honor a written request for enrollment if the mail is stamped by March 31, said Elizabeth Gavino, founder of Lewin & Gavino and an independent broker and general agent for Medicare plans.
As mentioned, if you’re signing up late during the current three-month window, your coverage won’t start until July. This is the case whether you stick with basic Medicare (Parts A and B) or sign up for an Advantage Plan (Part C).
That option, offered by private insurance companies, delivers Parts A and B and, usually, Part D (prescription drug coverage), as well as other extras like dental and vision. If you want to go this route, you can sign up from April 1 to June 30.
If you plan to pair Parts A and B with a supplement plan — aka, Medigap — you have to wait as well for that coverage. These plans cover some of the cost-sharing that comes with basic Medicare, such as deductibles or copays.
“Once Part B goes into effect, this will trigger their six-month Medigap open enrollment so they can choose a plan with no health questions asked,” Roberts said.
Beyond that window, you would have to undergo medical underwriting — which could result in being denied coverage or paying more — unless you live in a state with different Medigap enrollment rules.
As for prescription drug coverage, your options depend on your situation. If you already have been enrolled in Part A and have had “creditable” drug coverage up until now — which could be the case with a small employer plan — and only missed your signup deadline for Part B, you’d get a two-month special enrollment period to get Part D coverage once you lose the workplace plan, Roberts said.
Once Part B goes into effect, this will trigger their six-month Medigap open enrollment so they can choose a plan with no health questions asked.
Co-founder of Boomer Benefits
On the other hand, if you haven’t had acceptable drug coverage while having Part A, your option now would be to sign up for an Advantage Plan (again, April through June, after signing up for Part B before March 31) or to wait until the fall open enrollment to pick a standalone Part D plan.
It’s worth noting that if you face a gap with no health coverage between now and July, you can look into insurance plans through the federal (or your state’s) health-care exchange, Roberts said. You also could explore short-term plans, although they may lack broad coverage or reject individuals with pre-existing conditions.
For each full year that you should have been enrolled in Part B but were not, you could face paying 10% of the monthly Part B standard premium ($148.50 for 2021). The amount is tacked on to your monthly premium, generally for as long as you are enrolled in Medicare.
For Part D prescription drug coverage, the late-enrollment penalty is 1% of the monthly national base premium ($33.06 in 2021) for each full month that you should have had coverage but didn’t. Like the Part B penalty, this amount also generally lasts as long as you have drug coverage.